Improving Star Ratings
By. M Smith
Amidst our rapidly-changing industry landscape, the Star Ratings program essentially serves as a “Medicare Advantage stress test,” measuring a plan’s ability to master the operational complexities encountered while improving the quality of care and general health status of Medicare beneficiaries through member-pleasing experiences. At any given time, there are multiple Star Ratings cycles in play. For example: operational teams and providers have now shifted their focus to services impacting 2018 Star Ratings, Quality and Pharmacy teams are beginning to finalize Healthcare Effectiveness Data and Information Set (HEDIS®) and Prescription Drug Event (PDE) data for 2017 Star Ratings, and the Star Ratings team is feverishly working to optimize performance across both the 2017 and 2018 Star Ratings cycles.
As we’ve said before, there is no rest for the weary within Star Ratings, and 2016 will likely be no different. But January is a time for new beginnings and fresh starts, so we want to provide you with a few helpful tips to start off the New Year strong:
Monitor and Manage Execution Risk
We are watching a slew of significant industry issues this year. Some of these issues will directly impact Star Ratings workflows (such as potential new measures, potential program changes to account for dual eligibles/low-income subsidy (LIS) members, and the evolution of Medication Therapy Management (MTM), some will directly impact Star Ratings strategy (such as mergers, drug pricing, provider networks, and care delivery), while others will have an indirect impact on Star Ratings. The Star Ratings impact of these issues and risks, combined with the impact of internal and local risks and issues, will continue to evolve and may change unpredictably throughout the year. It’s important for health plan leaders to understand the Star Ratings impact associated with these, and other, types of issues so risks can be routinely evaluated and mitigated where possible. Just as importantly, monitor and evaluate your internal execution risks so mitigation strategies can be deployed when staffing challenges, organizational changes, or administrative processes are not functioning as designed. Make sure your Star Ratings reporting, monitoring, and oversight processes spotlight these risks so leadership is aware of key risks and can adjust the sails as needed if the winds change during the year.
Align Your 2016 Star Ratings Work Plan with Your Strategic Plan.
Health plans are updating their strategic plans more frequently, and often more significantly, than in the past to account for the nature, extent, and speed of industry changes. It is not uncommon for staff to invest time, effort, and resources in selected areas only to later discover there were other, more critical, areas which could have yielded a higher return on investment (ROI) from Star Ratings-related investments. Star Ratings success amidst a changing industry will test a plan’s flexibility, agility, and leadership. With that in mind:
Ensure your 2016 Star Ratings work plan aligns with your organization’s strategic plan and captures activities needed to mitigate the impact of strategic adjustments.
When planning for strategic change, engage Star Ratings leaders to ensure leadership is prepared for, and can mitigate the impact of, such strategic change on Star Ratings. As changes are made, help department leaders understand the full scope of change and its impact on Star Ratings and deploy well-planned tactics to mitigate Stars Ratings risk as changes are implemented.
Align Star Ratings strategies and tactics with population health, quality improvement, and care management workstreams, and cross-leverage member interventions to simultaneously achieve cross-functional purposes.
Evaluate the impact of your delegates and vendors on your Star Ratings strategic goals and deploy targeted efforts where improvement is needed.
Run Star Ratings as a Strategic Program
A health plan’s Star Rating ultimately reflects the effectiveness with which the entire organization (and its first-tier, downstream, and related entities) and its provider/pharmacy networks work together to improve quality of care and the health status of Medicare beneficiaries in ways which meet members’ expectations. As Star Ratings expand into long-standing, multi-faceted new clinical areas, health plans may discover a need for increased collaboration among internal teams and with providers. With this in mind, it is important plans run Star Ratings as a strategic program with dedicated leadership, well-documented workflows, and carefully-crafted leadership support to best ensure the plan hits the ever-important 4-Star threshold.